Medical errors in the testing process (ordering, tracking, documentation, patient notification, and follow-up) are critical problems in primary care. However, little is known about the safe performance of the testing process, especially in the smaller, independent practices so common in this country. As a fellowship-trained family physician who is experienced in qualitative research methods, the applicant is committed to the development of novel approaches to medical error reduction, approaches that are grounded in clinical reality and informed by a human factors engineering (HFE) theoretical perspective. Working according to a structured program of courses, seminars, research collaborations and work on a specific project, Dr. Nancy Elder will learn HFE theory and methods, acquire a background in organizational change, and strengthen her quantitative analysis skills. It is her research goal to make use of HFE techniques to understand the primary care testing process, to identify tasks that are critical to safety, and to organize them within a human factors model to provide the basis for developing future quality improvements. Dr. Elder's specific aims are to: 1) Identify critical safety gaps using a proposed Human Factors -Testing Process (HF-TP) Model; 2) Describe the flow of functions and tasks through a HFE study of family practice offices; 3) Revise and validate the HF-TP Model and identify functions critical to patient safety; and 4) Identify barriers and promoters of future safety improvement interventions. The methods by which she intends to conduct this research include: 1) the classification of existing testing process error reports within a validated human factors framework (Eindhoven) and applying the classifications to a conceptual HF-TP Model; 2) performance of HFE task analyses at four diverse practices, using interviews, structured observations, surveys, and review of documents to assess protocols and tasks, counts of near-misses and errors, cognitive aids, physical environment, technology and patient input; 3) application of the results from the HFE analysis to the HF-TP model to identify a subset of human factors categories that lead to frequent or high-risk error situations and performing additional HFE analyses at eight to ten practices to validate and expand the HF-TP model; and 4) the conduct of focus groups with participants at these eight to ten practices to identify barriers and promoters of organizational change that could lead to improvements in the testing process. Through this research project, the candidate intends to develop into an independent patient safety investigator and, through this research, she will develop a robust human factors model of the testing process that will lead to novel approaches for effective error prevention and recovery. [unreadable] [unreadable]